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Endometrial Cells on Pap Smear and Endometrial Cancer

Am Fam Physician. 1999 Jan 15;59(2):440-443.

Endometrial cancer is one of the more common gynecologic malignancies in the United States. Despite recent advances, approximately 6,000 deaths result from endometrial cancer each year. Several studies have suggested a correlation between endometrial cells (both normal and abnormal) on Papanicolaou smears and endometrial cancer, mainly in post-menopausal women. Kerpsack and associates conducted a study to evaluate a possible correlation between the presence of endometrial cells on Pap smear and significant endometrial pathology.

All Pap smears from a medical foundation patient population over a three-year period were reviewed. Of 119,000 Pap smears in the screening pool, 61 included endometrial cells. Nine patients were lost to follow-up and five had no further testing and were classified as of benign etiologies; the remaining patients received endometrial aspiration, endometrial curettage or hysterectomy for tissue confirmation. Thirty-one of the patients had benign endometrial cells on Pap smear. Five patients had atypical glandular cells of undeterminant significance suggestive of endometrial cells, 11 patients had atypical endometrial cells and four patients had adenocarcinoma. Forty-four patients were postmenopausal; 12 of these women were taking hormone replacement therapy. Twenty-four of the patients had abnormal vaginal bleeding. In the final analysis, 45 patients were found to have benign disease and seven patients had carcinoma. Two patients with endometrial cancer had benign endometrial cells on their Pap smears; the remainder had more advanced abnormalities. The majority of patients with endometrial cancer had abnormal vaginal bleeding.

The authors conclude that asymptomatic patients who have benign endometrial cells on Pap smear but no abnormal vaginal bleeding do not require further evaluation. However, even if the endometrial cells are described as benign, a patient with abnormal vaginal bleeding should receive further evaluation with dilatation and curettage.